…of a pacemaker. The pacemaker is commonly implanted under the clavicle, between the skin and the pectorialis major. The pulse generator has a shell of…

…pacemaker systems consist of a pulse generator and one lead, which is located either in the right atrium or the right ventricle. Such systems are…

…Whether electrosurgery or diathermy will be used. Whether monopolar or bipolar electrocautery is planned. The operative site in relation to the pulse generator and the

…etc. Most cases of malfunction are associated with the electronics in the pulse generator or dislodgement or fracture of the leads. External causes are less…

…hits the piezoelectric crystals, they begin to vibrate and generate electric currents, which are transmitted to the ultrasound machine for analysis. The reflected sound waves…

…CPR generates approximately 25% of normal cardiac output, which postpones or mitigates cerebral injuries. No flow time and low flow time are critical parameters for…

…direction of blood flow, otherwise, the calculations will be uncertain. This is explained by the fact that each ultrasound pulse generates a snapshot of blood…

…retention for the latter. The treatment is also time limited by its very nature: a patient who has not responded within a couple of hours…

…The ultrasound transducer generates short bursts (pulses) of ultrasound waves. Reflected ultrasound waves are analyzed by the machine during the brief pauses between the pulses…

…high amplitude. This is due to the high density of myocardium. It follows that myocardium generates reflections with high amplitude and low Doppler shift. To…

…include: Assessment of all major peripheral pulses. Blood pressure measurement in both arms. Cardiac auscultation. Pulmonary auscultation. Evaluation for heart failure. Assessment for circulatory compromise…

…a result of tachyarrhythmia, bradyarrhythmia or asystole. The tachyarrhythmias include ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). The bradyarrhythmias include all bradyarrhythmias, pulse less…

…Do not wait for the blood gas result before starting treatment. Clinical assessment History that affects the level of risk Ask briefly and to the…

…departments; a palpable ulnar pulse and a warm, well perfused hand carry more weight. Choice of vessel The radial artery is the first choice : superficial…

…measures of perfusion Parameter Normal Comment : : : Heart rate 50–100/min MAP 70–105 mmHg Target ≥ 65 mmHg in shock; higher in known hypertension Pulse…

…pulmonary oedema, myocardial ischaemia or a falling level of consciousness. Unstable monomorphic VT with a pulse. Pre excitation with atrial fibrillation and a very rapid…

…airway, breathing, circulation and level of consciousness. 2. Attach ECG, pulse oximetry and repeated blood pressure measurement when a hypertensive emergency is suspected. 3. Insert…

…look for the cause instead. Conditions in which the highest possible oxygen concentration is given irrespective of the saturation Carbon monoxide poisoning. The pulse oximeter…

…local source for the current indication, dosing, sampling and duration of treatment. International guidelines must be adapted to the antidotes, analytical methods and treatment protocols…

…rhythm through the cable, not through the pads. A pulse oximeter, a blood pressure cuff, and an arterial line for prolonged pacing. Venous access, oxygen…

…pulse deficits, and malperfusion are less frequent in type A IMH. IMH is classified anatomically according to the Stanford system: Type A IMH: involves the…

…J shaped associations are considered unreliable for guiding treatment because of potential confounding, reverse causality, and the association of arterial stiffness with both low DBP…

…or a reduced requirement for antihypertensives, should prompt clinical suspicion [1]. Cardiac Signs and Symptoms Patients often present with symptoms of predominant right heart failure…

…Right ventricular systolic and pulse pressures are reduced. The central management principle is preservation of adequate right ventricular preload while supporting left ventricular performance and…

Echocardiography Color Doppler Velocities recorded in a sample volume of the pulsed wave Doppler can be presented with a color. A color scale from blue…

…for every 10,000 apparently healthy newborn infants, around six will have critical CHD, and the pulse oximetry test will correctly identify five of these…

…of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves. The cardinal difference between continuous wave Doppler and pulsed…

…set a lower goal regarding workload (e.g. reaching 70% of maximal pulse instead of 85%). Many patients appreciate the exercise test because it offers…

…at high risk of developing atrial fibrillation, and vice versa. The pathophysiological explanation for this may be a general degeneration of the atrial conduction system…

…for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other extracorporeal therapy (requires a large bore dialysis catheter, not an ordinary triple lumen catheter). Measurement of…

…minutes . 4. Give 2 mg of edrophonium intravenously as a test dose . Observe pulse, blood pressure and muscle strength for a few minutes. 5. If…

…must be ready before induction , not looked for afterwards. Monitoring: ECG, pulse oximetry and blood pressure at short intervals. Tube size and depth Patient Internal…

…ECG changes at any level Immediate emergency treatment, continuous ECG monitoring and early assessment of the need for dialysis ECG changes or serious neuromuscular symptoms…

…a narrow pulse pressure, peripheral vasoconstriction, impaired consciousness, a rising lactate or a worsening acidosis. An assessed need for at least 4 units of red…

…depression, or untreated severe respiratory failure without the possibility of monitoring. Paralytic ileus and suspected obstructive ileus (an opioid can be given for the pain…

…Clinical probability in the stable patient The Wells criteria for pulmonary embolism: Criterion Points : : Clinical signs of deep vein thrombosis 3 Pulmonary embolism is the…

…the greater the risk of chondral and neurovascular injury. Aim for reduction within a few hours. Contraindications A fracture dislocation requiring operative treatment — contact an…

…the first instance. Give small boluses, for example 250 to 500 mL, with immediate reassessment of the blood pressure, pulse, peripheral perfusion, mental state and…

…motor function, capillary refill and pulse, and active movement of every tendon crossing the wound. A tendon injury can be painless and gives normal passive…

…Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual for inotropes and vasopressors Drug Indications Dose α1 effect β1 effect β2 effect…

…SBP] – DBP) This formula accounts for the longer duration of diastole compared to systole. Clinical utlility Monitoring MAP is essential for assessing adequate organ perfusion…

…tamponade, and sudden: Loss of pulse. Loss of blood pressure. Loss of consciousness. Electromechanical dissociation or pulseless electrical activity despite ongoing sinus rhythm on the…

…for Extracorporeal Membrane Oxygenation (ECMO) initiation ( Soar et al ). ETCO 2 trends can vary during CPR depending on various factors such as the cause of…

…Overview of vasopressors and inotropes Inotropes and vasopressors. Table 1. Drug manual for inotropes and vasopressors Drug Indications Dose α1 effect β1 effect β2 effect…

…conduction system. The AV system consists of the AV node , the bundle of His and the Purkinje fibers . These structures transmit the atrial pulse to…

…in two separate points in the system (Figure 1). Figure 1. The Bernoulli principle. According to the Bernoulli principle, the sum of kinetic energy (K)…

…using Pulsed Doppler. Tissue Doppler is used to measuring mitral annular plane velocity. The American Society for Echocardiography (ASE) and the European Association of Cardiovascular…

…Palpable foot pulses are not an acceptable substitute, and in patients with diabetes or renal failure the index may be falsely normal because of medial…

…2D measurements in the future. Cardiac MRI (magnetic resonance imaging) is considered the gold standard for the calculation of ejection fraction. Recommended chapter: Ejection fraction…

…delivers the pulses). The depolarizing wave spreads outside the conduction system, which is considerably slower, as compared with impulse transmission within the conduction system (His…

…over a joint. Pain relief and stabilisation for transfer in a suspected fracture. Clinical suspicion of a scaphoid fracture despite a normal radiograph. Contraindications An…

…may be reduced. Other possible findings include muscle stiffening and loss of deep tendon reflexes. Pulses are absent distal to the obstruction, although Doppler examination…

…should include: palpation of peripheral pulses; auscultation for carotid, femoral, and abdominal bruits; bilateral brachial blood pressure measurement; cardiac auscultation; inspection of the legs and…

…current guidelines, laypeople do not need to perform the 3 rd assessment (reliable assessment of pulses requires training and experience). Thus, for laypeople, examinations 1…

…affects ventricular relaxation (and thus ventricular filling). This may even lead to compression of the ventricles during diastole; cardiac tamponade occurs if excess pericardial fluid…

…phase of diastole–the rapid filling –which can be studied using pulsed Doppler. The sample volume (in apical view) is placed at the tips of…

…speed of the motion. Myocardial motion and velocity can be measured with pulsed tissue Doppler (see Pulsed Wave Doppler). Tissue Doppler allows for sampling of…

…period. VTI is also called stroke distance. Figure 2 illustrates the recording of VTI using pulsed wave doppler in the aortic valve. Figure 2. VTI…

…views. The increased pressure may also propagate back to the right atrium and venous system, resulting in dilation of vena cava inferior ( 2.1 cm)…